Healthbeat: Battling heartburn and reflux

Sunday

Apr 14, 2013 at 2:00 AM

A high percentage of Americans suffer from "acid indigestion" or "heartburn." Others may be diagnosed with GERD (gastroesophageal reflux disease). These conditions may be triggered or worsened by the typical American diet and lifestyle habits. Their incidence has also risen with the increase in overweight and obesity. Exactly what are these conditions and how can we address their symptoms?

Pam Stuppy

A high percentage of Americans suffer from "acid indigestion" or "heartburn." Others may be diagnosed with GERD (gastroesophageal reflux disease). These conditions may be triggered or worsened by the typical American diet and lifestyle habits. Their incidence has also risen with the increase in overweight and obesity. Exactly what are these conditions and how can we address their symptoms?

In both, acid from the stomach flows upward into the lower end of the esophagus. This can be caused by pressure pushing upward, or relaxation of the otherwise tight muscle that normally keeps acid in the stomach. Pressure can be caused by overeating at a meal, pregnancy, some types of exercise, or being overweight. In the case of the muscle, it can be affected by actual changes in the muscle or substances that relax the muscle. The symptoms can be a burning sensation and/or pain.

Some foods/beverages can cause the muscle to relax, as can some medications. Stress, lack of sleep and smoking can also contribute to indigestion. Eating, especially large amounts, shortly before bedtime is another factor. Some people have physical changes in the esophagus, like a hiatal hernia, that cause reflux as well.

Despite the name, heartburn is not a condition of the heart, but the symptoms can mimic heart conditions. Unfortunately, some people dismiss symptoms of heart problems, by blaming them on indigestion. Occasional indigestion or heartburn is not a problem. When it occurs on a regular basis, as in GERD, however, it can cause ulceration in the esophagus, bleeding ulcers, and an increased risk of esophageal cancer.

GERD is diagnosed when the reflux becomes more chronic and problematic — occurs more than twice a week, becomes worse even with increasing doses of over-the-counter antacids, causes problems with sleep, interferes with normal activities, causes hoarseness or worsening of asthma, invokes a chronic cough, causes chest pain, causes trouble swallowing, or causes a loss of appetite due to symptoms.

As noted, there are some foods that contribute to the cause of reflux, while other foods are more likely to irritate already inflamed tissues. Examples of those that can trigger relaxation of the muscle would be fatty foods, alcohol, chocolate, coffee, tomato, onion, garlic, mint, caffeine and carbonated beverages.

When it comes to fiber, try including more soluble fiber foods (the softer fibers) found in oats, cooked vegetables and skinned fruit. Cooking raw vegetables (steam, sauté, or roast) can reduce the abrasion. It can be helpful to keep a food/beverage and symptom record to identify triggers.

Other habits that can be helpful might be eating smaller, frequent meals (rather than a few large meals), eating slowly, and chewing food thoroughly. You should also try stopping eating about two to three hours before bedtime and sleeping with your upper body elevated. Keep up with fluid intake — at least 64 ounces spread throughout the day. Wear loose fitting clothes to decrease pressure. Reducing stress is another good idea.

If being overweight is contributing to the reflux, weight loss would be advised. Healthy weight loss should be achieved by eating smaller portions of healthy foods spread over three meals with healthy snacks between. This pattern can help reduce total calorie intake while sustaining energy levels and putting you in better control over food choices. The smaller portions and more consistent food intake can directly improve the reflux as well. You should also make sure that your diet is nutritionally adequate, since some foods may be limited owing to reduced food intake and because you are avoiding reflux triggers.

Some nutrients depend on stomach acidity for availability and uptake. The use of medications that reduce stomach acidity may help with the reflux, but can interfere with these nutrients. Vitamin B12 is an example of this, so it is recommended that you take a vitamin B12 supplement. The supplemental form does not depend on stomach acid in order for the body to take it in.

Calcium is another example. If you are taking a calcium supplement, make sure it is calcium citrate, which does not depend on stomach acidity for absorption, rather than calcium carbonate, which does.

Absorption of iron and magnesium can also be negatively affected by some of the meds (H2 blockers, proton pump inhibitors, antacids). Take these separately from a multivitamin, or iron or magnesium supplements by at least two hours.

Other actions you can take are to quit smoking, improve sleep habits, limit alcohol and reduce stress as much as possible. By making these and the dietary changes noted, you can improve symptoms and the concern for more problematic issues in the future.

Pam Stuppy, MS, RD, CSSD, LD, is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy. Visit www.pamstuppynutrition.com for nutrition information, healthy cooking tips and recipe ideas.

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.

Advertise

Original content available for non-commercial use under a Creative Commons license, except where noted.
seacoastonline.com ~ 111 New Hampshire Ave., Portsmouth, NH 03801 ~ Privacy Policy ~ Terms Of Service